Can Fat Injections Replace Injectable Filler Treatments?

How successful are fat injections to the nasolabial folds of the face? Is it a more permanent solution than Restylane, Perlane and Juvederm? What is the downtime and the average cost?

Doctor Answers 39

Fat grafts are not the best solution for nasolabial folds

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Although fat transfer is revolutionizing facial and body aesthetic surgery, there are some regions were fat grafting is not as effective as other fillers on the market. One fo those regions is the nasal labial folds. Fat grafts don't seem to persist very long in this location. This could be due to a number of factors. For patients in our clinic, our recommendation is to use an HA filler like Restylane, or a 'permanant' filler like Artefill.

Fat Injections vs. Temporary Fillers

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A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume or have developed deep lines and creases. Probably the most popular fillers currently are hyaluronic acid products like Restylane and Juvederm, which can be used to plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). The improvement generally lasts four to six months.
Some synthetic materials are available which can be used in an attempt to produce a permanent soft tissue augmentation. Unfortunately, the body treats such materials as foreign objects, and as a result the placement of synthetic materials may lead to inflammation, infection, migration and granuloma formation. In general, synthetic materials are less likely to produce a result that looks and feels natural.
Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.
I perform a procedure called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements facial aesthetics are possible

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Fat grafting is a nice alternative to fillers

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Fat grafting is a nice alternative to fillers. It can achieve the same results as the fillers, but has the potential to last much longer and, possibly, permanently. Make sure that you go to someone with extensive experience in fat grafting, since you want to get it done correctly the first time. Basically, the fat is harvested from your abdomen or thigh with a mini-lipousuction technique. The fat is then processed (we use a centrifuge in my office) to isolate or concentrate the fat cells. The fat is then put into syringes and injected in a similar way as the off-the-shelf fillers. You should expect a bit more temporary bruising and swelling with the fat grafting than with the fillers. This is due to the fact that the fat should be injected into multiple levels and directions for a smooth, even look. Additionally, this helps increase the chance of the fat lasting since it will be distributed closer to the micro blood supply of the skin and subcutaneous tissue. If they are suggesting that you have fat grafting around your eyes, question them extensively about their experience and ask to see several before and after photos of their patients. Injecting fat in the lips and nasolabial crease is fairly routine. However, injections around the eyes can lead to big problems in inexperienced hands. The fat grafting procedure usually costs a bit more than the fillers, but it has the potential to last much longer. So, your cost savings in the long run is great. In my office, the fat grafting procedures generally run between $2000 and $4000 depending on the areas grafted (nasolabial crease, lips, cheeks, periorbital, pre-jowel, etc). Good luck with yoru procedure.

David Shafer, MD

Try LiveFill - also is tightening needed?

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Fat injections are considered by most doctors to have some permanent benefit. In our practice, we have studied and presented another option which has given superior results, LiveFill. Fat injection technique involves removal of fat cells from the body via liposuction. The cells are then usually spun in a centrifuge. They are then injected through a needle back into the face. This process kills (depending on the study you read and the technique used for measuring viability) most to nearly all of the cells. These dead cells cannot resurrect themselves.

LiveFill uses nontraumatized cells shaped into grafts which are then placed directly into hollow areas. The percentage of dead cells is very low, 12% in our studies (vs. 75% dead cells for Coleman technique fat aspiration). That means the number you are starting out with is higher, and your eventual success rate is higher as well. We demonstrated this with 3-dimensional CT scans measuring volume, presented the results at ASAPS and ASPS meetings, and published the results in Plastic and Reconstructive Surgery.

So yes, LiveFill is an alternative to temporary fillers.

Having said that, in most 62-year-old patients, there are usually two primary problems going on: loss of volume, and sagging of facial skin. Sagging of the skin cannot be overcome with obtuse amounts of volume replacement, in my opinion. Rather, a combination of a cleverly done facelift with volume restoration (with LiveFill grafts) gives the best long term results.

An old mentor of mine once said that if Plan A fails (i.e. temporary filler, temporary filler, temporary filler), make sure Plan B is not the same as Plan A (i.e. more temporary filler), but think of the problem differently. In this case, consider whether a facelift is the most appropriate way to rejuvenate the face.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Fat is not like the fillers named!

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As the inventor of the Viafill Fat Transfer system, I have a large body of experience with fat transfer. However, I still love Juvederm and Radiesse.

Each filler has its purpose.

Juvederm is great for fine lines and wrinkles. It is also great for lips and nasolabial folds when small volumes of fill are necessary. The downside is the short length of action.

Radiesse is great for filling deeper folds in areas like the nasolabial when small volumes are necessary. It also has the benefit of lasting longer than Juvederm.

Fat is great for large volumes and in areas that need to filldeeper areas. I like it for;

  • Tear Troughs
  • Temples
  • Cheeks
  • Hands
  • Breasts
  • Breast reconstructions

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Fat transfer can be a great way to permanently treat wrinkles

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Thanks for your question. As you know injectables like Restylane and Juvederm are temporary fillers that the body resorbs over time. Fat transfer is a permanent way to perform the same job that the temporary fillers do. Fat transfer can be a good second operation for patients that have had fillers and liked the effect.

The concept is to remove fat from a less desirable area (usually the abdomen or flanks) using liposuction and transfer it to an area that needs it - in your case the nasolabial folds - using lipoinjection.

Challenges to the procedure include getting the fat to survive, not over or under correcting and creating a smooth contour. Make sure you find a board certified plastic surgeon who has experience with this technique as there is a significant learning curve to produce good results, especially in the nasolabial folds. I hope this helps.

Steven Williams, MD

Fat Does Not Work Well for the Nasolabial Folds

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In my experience, fat does not work well for the nasolabial folds. Some surgeons have had success using the Surgiwire to release the nasolabial folds and then injecting fat. Unfortunately, I have treated several patients who underwent fat augmentation in the nasolabial folds and ended up having the fat settle on either side of the fold and actually create a deeper fold.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Facial fat injection can be very successful

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Facial fat grafting can be very successful when used appropriately by an experienced surgeon.  Facial fat grafting can be used instead of synthetic fillers in many areas, but sometimes a combination of different fillers can be beneficial.  The main advantage of fat grafting, other than it is your own tissue, is that larger volumes can be utilized than with synthetic fillers.  This is particularly beneficial in the cheeks, jawline, temples, and other areas of the body requiring larger volumes.  Though fat-grafting may initially may be more expensive, it typically lasts longer than synthetic fillers and you do not have to purchase the product.  Recent experience with water-assisted liposuction (body-jet) for fat harvesting has gained popularity since the harvested fat cells remain intact which can provide better survival and improve the overall result. The presence of viable stem cells within the harvested fat using this technique may also provide an added benefit not realized with other techniques.  The typical downtime with facial fat grafting is a little longer than with the synthetic fillers, so for small volume areas, I would still recommend using Juvederm or Radiesse with predictable results.  Good luck to you. 

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 72 reviews

Hyaluronic fillers beat fat injections in the face

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My experience was that I could not get fat injections to last very long for the NL folds. I was also unhappy wth uneveness and bump formation in areas where the skin was thinner.

I have not had these issues using any of the fillers, and the results are much more predicatble. Also, there is no need to take fat from another area (which can be quite sore!)

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

Fat is the perfect filler

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Fat is an excellent filler. The benefits of auto-fat transfer is that it is your own body and you will not have an allergic reaction to it. It is excellent for high volume filling. There is the potential for it to be permanet, since it is transfered as a graft. The exact amount that last long term is variable and really does depend on technique and physician experience. In my experience approximately 50% survives long term in the upper face, I tgend to gett 100% take in the buttock area.

Fat also has a small percentage of stem cells which will convert to the area it's injected into.

The cost is variable. In my practice, a face injected high volume under anesthesia costs roughly $4000. The nasolabial folds under local is $1500

Irvin M. Wiesman, MD
Chicago Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.